The severe acute respiratory syndrome coronavirus 2 (SARS‐Cov‐2), responsible for the coronavirus disease COVID‐19, was first identified in Wuhan, China in December 2019. Diabetes, as well as other ...cardiovascular comorbidities, has been recognized as a major risk factor for outcomes and mortality in adults with COVID‐19, particularly in the elderly with type 2 diabetes. Based on these conclusions, COVID‐19 data on adults have been generalized to youth with diabetes. Nevertheless, experience from pediatric diabetes practices in China (Wuhan), Italy, Spain (Catalonia), and the United States (San Francisco Bay Area) consistently report only a single severe case of COVID‐19 in a 20‐year‐old female youth with type 1 diabetes (T1D) that was hospitalized for bilateral pneumonia and was subsequently discharged without complications. In Italy, information on COVID‐19 in all children with diabetes is collected on a weekly basis and those with positive swab test or infection‐related symptoms reported to a dedicated national registry. Of a total of 15 500 children tested, 11 subjects with T1D (age 8‐17y) tested positive for COVID‐19; 6/11 were asymptomatic and the rest presented with mild symptoms. In the rest of locations, youths with T1D diagnosed with COVID‐19 were based on clinical suspicion and a confirmatory PCR test (Wuhan:0; Catalonia‐HSJD:3; California‐Stanford:2). All of them were asymptomatic or had a mild course. We suggest that COVID‐19 data from adults should not be generalized to children, adolescents, and youth with diabetes as their outcomes and prognosis seem to be similar to their non‐diabetic‐peers and consistently milder than adults with diabetes.
Background
Telemedicine for routine care of people with diabetes (PwD) during the COVID‐19 pandemic rapidly increased in many countries, helping to address the several barriers usually seen.
...Objective
This study aimed to describe healthcare professionals' (HCPs) experience on telemedicine use in diabetes care and investigate the changes and challenges associated with its implementation.
Methods
A cross‐sectional electronic survey was distributed through the global network of JENIOUS members of ISPAD. Respondents' professional and practice profiles, clinic sizes, their country of practice, and data regarding local telemedicine practices during COVID‐19 pandemic were investigated.
Results
Answers from 209 HCPs from 33 countries were analyzed. During the pandemic, the proportion of PwD receiving telemedicine visits increased from <10% (65.1% of responders) to >50% (66.5%). There was an increase in specific privacy requirements for remote visits (37.3% to 75.6%), data protection policies (42.6% to 74.2%) and reimbursement for remote care (from 41.1% to 76.6%). Overall, 83.3% HCPs reported to be satisfied with the use of telemedicine. Some concerns (17.5%) about the complexity and heterogeneity of the digital platforms to be managed in everyday practice remain, feeding the need for unifying and making interoperable the tools for remote care. Also, 45.5% of professionals reported to feel stressed by the need for extra‐time for telemedicine consultations.
Conclusions
Telemedicine was rapidly and broadly adopted during the pandemic globally. Some issues related to its use were promptly addressed by local institutions. Challenges with the use of different platforms and for the need of extra‐time still remain to be solved.
Type 1 diabetes (T1D) is the most frequent form of diabetes in pediatric age, affecting more than 1.5 million people younger than age 20 years worldwide. Early and intensive control of diabetes ...provides continued protection against both microvascular and macrovascular complications, enhances growth, and ensures normal pubertal development. In the absence of definitive reversal therapy for this disease, achieving and maintaining the recommended glycemic targets is crucial. In the last 30 years, enormous progress has been made using technology to better treat T1D. In spite of this progress, the majority of children, adolescents and young adults do not reach the recommended targets for glycemic control and assume a considerable burden each day. The development of promising new therapeutic advances, such as more physiologic insulin analogues, pioneering diabetes technology including continuous glucose monitoring and closed loop systems as well as new adjuvant drugs, anticipate a new paradigm in T1D management over the next few years. This review presents insights into current management of T1D in youths.
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•Achieving and maintaining the recommended glycemic targets for type 1 diabetes is crucial to avoid complications.•Most youths do not reach the recommended targets for glycemic control.•The development of new advances in therapies will offer new treatment opportunities.•New insulin analogues, diabetes technology and adjuvant drugs showed promising results in improving glycemic control.
Background
Intensified insulin delivery using multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII) is recommended in children with type 1 diabetes (T1D) to achieve good ...metabolic control.
Objective
To examine the frequency of pump usage in T1D children treated in SWEET (Better control in Paediatric and Adolescent diabeteS: Working to crEate CEnTers of Reference) centers and to compare metabolic control between patients treated with CSII vs MDI.
Methods
This study included 16 570 T1D children participating in the SWEET prospective, multicenter, standardized diabetes patient registry. Datasets were aggregated over the most recent year of treatment for each patient. Data were collected until March 2016. To assess the organization of pump therapy a survey was carried out.
Results
Overall, 44.4% of T1D children were treated with CSII. The proportion of patients with pump usage varied between centers and decreased with increasing age compared with children treated with MDI. In a logistic regression analysis adjusting for age, gender and diabetes duration, the use of pump was associated with both: center size odd ratio 1.51 (1.47‐1.55), P < .0001) and the diabetes‐related expenditure per capita odd ratio 1.55 (1.49‐1.61), P < .0001. Linear regression analysis, adjusted for age, gender, and diabetes duration showed that both HbA1c and daily insulin dose (U/kg/d) remained decreased in children treated with CSII compared to MDI (P < .0001).
Conclusions
Insulin pump therapy is offered by most Sweet centers. The differences between centers affect the frequency of use of modern technology. Despite the heterogeneity of centers, T1D children achieve relatively good metabolic control, especially those treated with insulin pumps and those of younger age.
Objective
The following report describes the evaluation of the ISPAD Science School for Physicians (ISSP) and for Healthcare Professionals (ISSHP) in terms of their efficiency and success.
Methods
...All past attendees from 2000–2019 ISSP and 2004–2019 ISSHP programs were invited to respond to an online survey to assess perceived outcomes of the programs on career development, scientific enhancement, scientific networking, and social opportunities.
Results
One‐third of the past ISSP (129/428), and approximately 43% of the past ISSHP attendees (105/245) responded to the surveys. Most of ISSP attendees reported that the programs supported their career (82%) by helping to achieve a research position (59%), being engaged with diabetes care (68%) or research (63%) or starting a research fellowship (59%). Responders indicated that ISSP was effective in increasing interest in diabetes research (87%) and enhancing the number (66%) and quality (83%) of scientific productions, and promotion of international collaborations (86%). After the ISSP, 34% of responders received research grants. From the first round of the ISSHP survey (2004–2013), responders reported have improved knowledge (60%), gained more confidence in research (69%), undertaken a research project (63%), and achieved a higher academic degree (27%). From the second round (2014–2019), participants indicated that the program was valuable/useful in workplace (94%) through understanding (89%) and conducting (68%) research and establishing communication from other participants (64%) or from faculty (42%). After the ISSHP, 17% had received awards.
Conclusions
From the participants' viewpoint, both programs were effective in improving engagement with diabetes research, supporting career opportunities, increasing scientific skills, and enhancing networking and research activities.
Objective
To establish whether diabetic ketoacidosis (DKA) or HbA1c at onset is associated with year‐three HbA1c in children with type 1 diabetes (T1D).
Methods
Children with T1D from the SWEET ...registry, diagnosed <18 years, with documented clinical presentation, HbA1c at onset and follow‐up were included. Participants were categorized according to T1D onset: (a) DKA (DKA with coma, DKA without coma, no DKA); (b) HbA1c at onset (low <10%, medium 10 to <12%, high ≥12%). To adjust for demographics, linear regression was applied with interaction terms for DKA and HbA1c at onset groups (adjusted means with 95% CI). Association between year‐three HbA1c and both HbA1c and presentation at onset was analyzed (Vuong test).
Results
Among 1420 children (54% males; median age at onset 9.1 years Q1;Q3: 5.8;12.2), 6% of children experienced DKA with coma, 37% DKA without coma, and 57% no DKA. Year‐three HbA1c was lower in the low compared to high HbA1c at onset group, both in the DKA without coma (7.1% 6.8;7.4 vs 7.6% 7.5;7.8, P = .03) and in the no DKA group (7.4% 7.2;7.5 vs 7.8% 7.6;7.9, P = .01), without differences between low and medium HbA1c at onset groups. Year‐three HbA1c did not differ among HbA1c at onset groups in the DKA with coma group. HbA1c at onset as an explanatory variable was more closely associated with year‐three HbA1c compared to presentation at onset groups (P = .02).
Conclusions
Year‐three HbA1c is more closely related to HbA1c than to DKA at onset; earlier hyperglycemia detection might be crucial to improving year‐three HbA1c.
Objective
To describe the association between height, demographics, and treatment in youths with type 1 diabetes participating in an international network for pediatric diabetes centers (SWEET).
...Methods
Data were collected from 55 centers with documented patients' height. All subjects below 20 years of age, diabetes duration >1 year, and without celiac disease were included. World Health Organization growth charts were used to calculate height and body mass index z‐scores. Multiple hierarchic regression models adjusting for known confounders were applied.
Results
Data on 22 941 subjects (51.8% male) were analyzed with a median and interquartile range for age 14.8 years (11.2, 17.6), diabetes duration 5.6 years (3.1, 8.9), and height z‐score 0.34 (−0.37, 1.03). Children were taller in the youngest age groups: adjusted height z‐scores of 0.31 (±0.06) and 0.39 (±0.06), respectively; with shorter diabetes duration (<2 years: 0.36 ±0.06; 2‐<5 years: 0.34 ±0.06; ≥5 years: 0.21 ±0.06) and if they were pump users: 0.35 ± 0.05 vs 0.25 ± 0.05 (>three injections/day and 0.19 ± 0.06 0‐3 injections daily), respectively. High hemoglobin A1c (HbA1c) and low to normal weight were associated with a lower height z‐score. Trends were identical in all models except for gender. No gender differences were found except in the final height model where females exhibited higher z‐score than males.
Conclusion
For youths treated at centers offering modern diabetes management, major growth disturbances are virtually eliminated. For children with a young age at onset, high HbA1c, injections, and/or non‐intensive diabetes, treatment still requires attention in order to attain normal growth.